# ZIVA MEDICAL PRIMARY CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144004821
- **Authorized official:** AMANDA SHURTZ (CEO)
- **Authorized official phone:** (573) 570-3555

## Contact information

- **Practice address:** 515 E PROMENADE ST STE 1, MEXICO, MO 65265-2966
- **Practice address phone:** (573) 570-3520
- **Mailing address:** PO BOX 197, LAKEWOOD, NJ 08701-0197

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 08/23/2023
- **Last updated:** 08/23/2023